Guyana 2009 Guyana Demographic and Health Survey Demographic and Health Survey 2009

Guyana

Demographic and

Health Survey 2009

Guyana 2009 Demographic and Health Survey

Guyana

Demographic and Health Survey 2009

Ministry of Health Georgetown, Guyana

Bureau of Statistics Georgetown, Guyana

ICF Macro (Technical Assistance)

October 2010

Ministry of Health

This report summarizes the results of the 2009 Guyana Demographic and Health Survey (2009 GDHS), implemented by the Ministry of Health (MOH) and the Bureau of Statistics (BOS), with technical assistance from ICF Macro. Funds for the survey were provided in their entirety by the local mission of the United States Agency for International Development (USAID/Guyana) under the MEASURE DHS program.

The 2009 GDHS is part of the worldwide MEASURE DHS program, which is designed to assist developing countries to collect, analyze, and disseminate data on fertility, family planning, and maternal and child health.

Additional information about the 2009 GDHS may be obtained from Bureau of Statistics (BOS)

Avenue of the Republic and Brickdam, Stabroek Georgetown, Guyana

Telephone: 592 225 6150 Fax: 592 226 2036

Web site: www.statisticsguyana.gov.gy

Additional information about the Demographic and Health Surveys program may be obtained from MEASURE DHS, ICF Macro

11785 Beltsville Drive, Suite 300 Calverton, MD 20705 USA

Telephone: 301-572-0200; fax: 301-572-0999 Email: reports@measuredhs.com

Web site: www.measuredhs.com

Suggested citation:

Ministry of Health (MOH), Bureau of Statistics (BOS), and ICF Macro. 2010. Guyana Demographic and

Health Survey 2009. Georgetown, Guyana: MOH, BOS, and ICF Macro.

CONTENTS

Páge

TABLES AND FIGURES ... ix

FOREWORD ... xvii

SUMMARY OF FINDINGS ... xix

BASIC INDICATORS... xxix

MAP OF GUYANA ... xxx

CHAPTER 1 INTRODUCTION 1.1 Overview ... 1

1.2 Objectives... 1

1.3 Sample Design... 1

1.4 Questionnaires ... 2

1.5 Pretest Activities, Training, and Fieldwork... 3

1.6 Data Processing ... 3

1.7 Response Rates... 3

1.8 Contents of the Report... 5

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Population... 9

2.1.1 Age-Sex Structure ... 9

2.1.2 Household Composition ... 11

2.1.3 Children’s Living Arrangements and Orphanhood ... 12

2.1.4 Educational Attainment... 14

2.1.5 School Attendance... 17

2.2 Housing Characteristics... 20

2.2.1 Drinking Water and Housing Characteristics... 20

2.2.2 Sanitation Facilities ... 24

2.2.3 Household Possessions... 25

2.3 Wealth Quintiles... 26

2.4 Birth Registration ... 27

CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Survey Respondents... 29

3.2 Educational Attainment of Respondents ... 31

3.3 Literacy... 33

3.4 Exposure and Access to Mass Media ... 36

3.5 Employment Status and Type of Occupation ... 38

3.6 Health Insurance Coverage ... 44

3.7 Knowledge and Attitudes Concerning Tuberculosis ... 47

3.8 Smoking ... 50

CHAPTER 4 FERTILITY 4.1 Current Fertility... 53

4.2 Fertility Differentials... 55

4.3 Fertility Trends ... 56

4.4 Children Ever Born and Living ... 57

4.5 Birth Intervals... 58

4.6 Age at First Birth... 60

4.7 Teenage Pregnancy and Motherhood ... 62

CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods... 65

5.2 Knowledge of Contraception by Background Characteristics ... 67

5.3 Ever Use of Contraceptive Methods ... 67

5.4 Current Use of Contraception... 69

5.5 Differentials in Current Use ... 71

5.6 Number of Children at First Use of Contraception ... 73

5.7 Use of Social Marketing of Brands of Pills and Condoms... 74

5.8 Sources for Family Planning Methods and Informed Choice ... 75

5.9 Contraceptive Discontinuation ... 78

5.10 Intention to Use Family Planning Among Non-users ... 78

5.11 Exposure to Family Planning in the Mass Media... 81

5.12 Contact of Non-users with Family Planning Providers ... 83

5.13 Husband/Partner's Knowledge of Women's Use of Contraception ... 84

CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status ... 85

6.2 Age at First Union ... 87

6.3 Age at First Sexual Intercourse ... 90

6.4 Recent Sexual Activity... 93

6.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility... 96

6.6 Termination of Exposure to Pregnancy... 98

CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children ... 101

7.2 Desire to Limit Childbearing by Background Characteristics... 104

7.3 Need and Demand for Family Planning Services... 106

7.4 Ideal Family Size... 110

7.5 Fertility Planning Status ... 111

7.6 Wanted Fertility Rates... 112

CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definition, Data Quality, and Methodology... 115

8.2 Current Estimates of Infant and Child Mortality... 116

8.3 Differentials in Infant and Child Mortality ... 117

8.4 Perinatal Mortality... 120

8.5 High-Risk Fertility Behavior... 122

CHAPTER 9 REPRODUCTIVE HEALTH 9.1 Antenatal Care... 125

9.1.1 Content of Antenatal Care... 128

9.1.2 Tetanus Toxoid Injections ... 129

9.2 Delivery Care ... 131

9.3 Postnatal Care... 135

9.4 Problems in Accessing Health Care ... 139

CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth ... 141

10.2 Vaccination of Children ... 143

10.2.1 Vaccination at Any Time before the Survey ... 143

10.2.2 Trends in Vaccination Coverage ... 146

10.3 Acute Respiratory Infection ... 147

10.4 Fever... 149

10.5 Diarrhea: Prevalence and Treatment ... 151

10.5.1 Prevalence of Diarrhea ... 151

10.5.2 Treatment of Diarrhea ... 153

10.5.3 Feeding Practices during Diarrhea ... 154

10.5.4 Knowledge of ORS Packets ... 155

10.5.5 Disposal of Stools... 156

CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Nutritional Status of Young Children ... 159

11.2 Breastfeeding... 165

11.2.1 Initial Breastfeeding ... 165

11.2.2 Breastfeeding Status by Age ... 167

11.2.3 Duration and Frequency of Breastfeeding... 169

11.3 Complementary Foods ... 170

11.4 Appropriate Infant and Young Child Feeding (IYCF) ... 172

11.5 Anemia in Children ... 175

11.6 Micronutrient Intake among Children ... 177

11.7 Presence of Iodized Salt in Households ... 180

11.8 Nutritional Status of Women and Men... 181

11.9 Foods Consumed by Mothers... 184

11.10 Anemia in Women and Men ... 186

11.11 Micronutrient Intake among Mothers... 189

CHAPTER 12 MALARIA

12.1 Ownership of Mosquito Nets ... 191

12.2 Use of Mosquito Nets by Children... 193

12.3 Use of Mosquito Nets by Women ... 195

12.4 Malaria during Pregnancy ... 197

12.5 Prevalence and Management of Childhood Malaria ... 199

CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Knowledge of AIDS... 201

13.2 Knowledge of HIV Prevention Methods... 203

13.3 Beliefs about AIDS ... 206

13.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV ... 210

13.5 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS... 212

13.6 Attitudes toward Negotiating Safer Sex ... 215

13.7 Attitudes toward Condom Education for Youth... 217

13.8 Higher-Risk Sex ... 218

13.8.1 Multiple Partners and Condom Use ... 218

13.8.2 Transactional Sex ... 222

13.9 Coverage of Prior HIV Testing ... 222

13.9.1 HIV Testing during Antenatal Care ... 226

13.10 Male Circumcision ... 228

13.11 Self-Reporting of Sexually Transmitted Infections... 229

13.12 Prevalence of Medical Injections ... 231

13.13 HIV/AIDS-Related Knowledge and Sexual Behavior among Young Adults ... 234

13.13.1 HIV/AIDS-Related Knowledge among Young Adults ... 234

13.13.2 Age at First Sex ... 236

13.13.3 Condom Use at First Sex... 238

13.13.4 Abstinence and Premarital Sex... 240

13.13.5 Higher-Risk Sex and Condom Use among Young Adults ... 242

13.13.6 Age Mixing in Sexual Relationships among Women ... 244

13.13.7 Drunkenness during Sex among Young Adults ... 246

13.13.8 Recent HIV Testing among Youth ... 248

CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14.1 Employment and Forms of Earnings... 251

14.2 Control over Women’s and Men’s Earnings ... 252

14.3 Women’s Participation in Household Decision-Making... 257

14.4 Attitudes toward Wife Beating... 262

14.5 Attitudes toward Refusing Sex with Husband... 266

14.6 Women’s Empowerment Indicators ... 271

14.7 Current Use of Contraception by Women’s Status ... 272

14.8 Ideal Family Size and Unmet Need by Women’s Status ... 273

14.9 Reproductive Health Care and Women’s Empowerment Status... 274

REFERENCES ... 277

APPENDIX A SAMPLE DESIGN... 279

A.1 Sample Frame ... 279

A.2 Sample Selection ... 279

A.3 Sample Allocation ... 280

A.4 Response Rates... 281

APPENDIX B ESTIMATES OF SAMPLING ERRORS ... 285

APPENDIX C DATA QUALITY TABLES... 309

APPENDIX D SURVEY PERSONNEL ... 315

APPENDIX E QUESTIONNAIRES ... 317

TABLES AND FIGURES

Page CHAPTER 1 INTRODUCTION

Table 1.1 Results of the household and individual interviews ...4

Table 1.2 Number of women and men interviewed by residence and region...5

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence ...10

Table 2.2 Household composition ...11

Table 2.3 Children’s living arrangements and orphanhood...13

Table 2.4.1 Educational attainment of the female household population...15

Table 2.4.2 Educational attainment of the male household population ...16

Table 2.5 School attendance ratios ...18

Table 2.6 Household drinking water...21

Table 2.7 Housing characteristics...23

Table 2.8 Sanitation facilities ...24

Table 2.9 Durable goods...25

Table 2.10 Wealth quintiles ...27

Table 2.11 Birth registration of children under age 5...28

Figure 2.1 Population Pyramid ...10

Figure 2.2 Percentage of Female-Headed Households by Residence ...12

Figure 2.3 Age-Specific School Attendance Rates, by Sex ...19

CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents...29

Table 3.2.1 Educational attainment of respondents: Women ...30

Table 3.2.2 Educational attainment of respondents: Men...32

Table 3.3.1 Literacy: Women ...34

Table 3.3.2 Literacy: Men ...35

Table 3.4.1 Exposure to mass media: Women...36

Table 3.4.2 Exposure to mass media: Men ...37

Table 3.5 Employment status ...39

Table 3.6.1 Occupation: Women ...42

Table 3.6.2 Occupation: Men ...43

Table 3.7 Type of employment...44

Table 3.8.1 Health insurance coverage: Women ...45

Table 3.8.2 Health insurance coverage: Men ...46

Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women...48

Table 3.9.2 Knowledge and attitudes concerning tuberculosis: Men ...49

Table 3.10.1 Use of tobacco: Women ...51

Table 3.10.2 Use of tobacco: Men...52

Figure 3.1 Respondents Completing Secondary or Higher Education, by Residence and

Wealth Quintile...33

Figure 3.2 Respondents Currently Employed, by Residence and Education...41

CHAPTER 4 FERTILITY Table 4.1 Current fertility ...54

Table 4.2 Fertility by background characteristics...55

Table 4.3 Trends in age-specific fertility rates ...56

Table 4.4 Children ever born and living ...57

Table 4.5 Birth intervals ...59

Table 4.6 Age at first birth...61

Table 4.7 Median age at first birth by background characteristics ...62

Table 4.8 Teenage pregnancy and motherhood ...63

Figure 4.1 Total Fertility Rates for the Three Years Preceding the Survey, by Residence...54

Figure 4.2 Births with a Birth Interval of Less than 24 Months, by Residence and Wealth Quintile...60

CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods ...66

Table 5.2 Knowledge of contraceptive methods by selected background characteristics ...67

Table 5.3 Ever use of contraception by age: Women ...68

Table 5.4 Ever use of contraception by age: Men ...69

Table 5.5 Current use of contraception by age ...70

Table 5.6 Current use of contraception by background characteristics ...72

Table 5.7 Number of children at first use of contraception ...74

Table 5.8.1 Brand of pills ...74

Table 5.8.2 Brand of condoms...75

Table 5.9 Source of modern contraception methods ...76

Table 5.10 Informed choice ...77

Table 5.11 First-year contraceptive discontinuation rates ...78

Table 5.12 Future use of contraception among non-users ...79

Table 5.13.1 Reasons for not intending to use contraception ...80

Table 5.13.2 Preferred method of contraception for future use ...81

Table 5.14 Exposure to family planning messages...82

Table 5.15 Contact of non-users with family planning providers ...83

Figure 5.1 Contraceptive Use among Currently Married Women, by Region...73

CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status by age and sex ...86

Table 6.2 Current marital status by background characteristics ...87

Table 6.3 Age at first union ...88

Table 6.4 Median age at first union by background characteristics ...89

Table 6.5.1 Age at first sexual intercourse: Women...91

Table 6.5.2 Age at first sexual intercourse: Men ...91

Table 6.6.1 Median age at first sexual intercourse, by background characteristics: Women ...92

Table 6.6.2 Median age at first sexual intercourse, by background characteristics: Men ...93

Table 6.7.1 Recent sexual activity: Women ...94

Table 6.7.2 Recent sexual activity: Men...94

Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility ...97

Table 6.9 Median duration of postpartum insusceptibility by background characteristics...98

Table 6.10 Menopause...99

Figure 6.1 Median Age at First Sexual Intercourse by Region ...92

CHAPTER 7 FERTILITY PREFERENCES Table 7.1.1 Fertility preferences by number of living children ...102

Table 7.1.2 Fertility preferences by background characteristics ...103

Table 7.2 Desire to limit childbearing by background characteristics...105

Table 7.3 Need and demand for family planning ...108

Table 7.4 Ideal number of children...111

Table 7.5 Fertility planning status ...112

Table 7.6 Wanted fertility rates ...113

Figure 7.1 Fertility Practices of Women in Union ...104

Firuge 7.2 Desire for No More Children by Region ...106

Figure 7.3 Components of the Unmet Need for Family Planning ...109

Figure 7.4 Women with Unmet Need and Demand Satisfied, by Region...109

CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates ...117

Table 8.2 Early childhood mortality rates by socioeconomic characteristics...118

Table 8.3 Early childhood mortality rates by demographic characteristics ...119

Table 8.4 Perinatal mortality ...121

Table 8.5 High-risk fertility behavior ...123

Figure 8.1 Infant Mortality Rates for the 10-Year Period Preceding the Survey, by Residence and Wealth Quintile ...119

Figure 8.2 Births in the Last Five Years and Women in Categories of High-risk Fertility Behavior...124

CHAPTER 9 REPRODUCTIVE HEALTH Table 9.1 Antenatal care ...126

Table 9.2 Number of antenatal care visits and timing of first visit...127

Table 9.3 Components of antenatal care...129

Table 9.4 Tetanus toxoid injections...130

Table 9.5 Place of delivery ...133

Table 9.6 Assistance during delivery...134

Table 9.7 Timing of postnatal care ...137

Table 9.8 Type of provider of first postnatal checkup...138

Table 9.9 Problems in accessing health care ...140

Figure 9.1 Two Tetanus Vaccinations during Last Pregnancy and Births Protected

against Neonatal Tetanus, by Residence ...131

CHAPTER 10 CHILD HEALTH

Table 10.1 Child’s weight and size at birth ...142

Table 10.2 Vaccinations by source of information...143

Table 10.3 Vaccinations by background characteristics...144

Table 10.4 Vaccinations in the first 18 months of life...147

Table 10.5 Prevalence and treatment of symptoms of acute respiratory infection (ARI)...148

Table 10.6 Prevalence and treatment of fever ...150

Table 10.7 Prevalence of diarrhea ...152

Table 10.8 Diarrhea treatment ...154

Table 10.9 Feeding practices during diarrhea...155

Table 10.10 Knowledge of ORS packets or pre-packaged ORS liquid ...156

Table 10.11 Disposal of children's stools ...157

Figure 10.1 Vaccination Coverage at Any Time before the Survey among Children 18-29 Months...145

Figure 10.2 Children Age 18-29 Months with All Vaccines at Any Time before the Survey, by Residence ...145

CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1.1 Nutritional status of children by demographic characteristics...162

Table 11.1.2 Nutritional status of children by socioeconomic characteristics ...164

Table 11.2 Initial breastfeeding ...166

Table 11.3 Breastfeeding status by child’s age...168

Table 11.4 Median duration and frequency of breastfeeding ...170

Table 11.5 Foods consumed by children in the day or night preceding the interview ...171

Table 11.6 Infant and young child feeding (IYCF) practices ...174

Table 11.7 Prevalence of anemia in children...176

Table 11.8 Micronutrient intake among children ...179

Table 11.9 Presence of iodized salt in the household ...180

Table 11.10.1 Nutritional status by background characteristics: Women ...182

Table 11.10.2 Nutritional status by background characteristics: Men...183

Table 11.11 Foods consumed by mothers in the day or night preceding the interview...185

Table 11.12.1 Prevalence of anemia: Women ...187

Table 11.12.2 Prevalence of anemia: Men ...188

Table 11.13 Micronutrient intake among mothers...190

Figure 11.1 Nutritional Status of Children under Age 5 ...153

Figure 11.2 Children under Five Stunted and Underweight, by Residence ...165

Figure 11.3 Infant Feeding Practices by Age...169

CHAPTER 12 MALARIA Table 12.1 Household possession of mosquito nets ...192

Table 12.2 Use of mosquito nets by children ...194

Table 12.3.1 Use of mosquito nets by women...196

Table 12.3.2 Use of mosquito nets by pregnant women...198

Table 12.4 Prevalence and prompt treatment of children with fever...200

CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES,

AND BEHAVIOR

Table 13.1 Knowledge of AIDS ...202

Table 13.2 Knowledge of HIV prevention methods...204

Table 13.3.1 Comprehensive knowledge about AIDS: Women...208

Table 13,3,2 Comprehensive knowledge about AIDS: Men ...209

Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV...211

Table 13.5.1 Accepting attitudes toward those living with HIV: Women...213

Table 13.5.2 Accepting attitudes toward those living with HIV: Men ...214

Table 13.6 Attitudes toward negotiating safer sex with husband ...216

Table 13.7 Adult support of education about condom use to prevent AIDS ...217

Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women...220

Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men ...221

Table 13.9.1 Coverage of prior HIV testing: Women ...224

Table 13.9.2 Coverage of prior HIV testing: Men...225

Table 13.10 Pregnant women counseled and tested for HIV...227

Table 13.11 Male circumcision ...228

Table 13.12 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms...230

Table 13.13 Prevalence of medical injections ...232

Table 13.14 Comprehensive knowledge about AIDS and of a source for condoms among youth ...235

Table 13.15 Age at first sexual intercourse among youth ...237

Table 13.16 Condom use at first sexual intercourse among youth ...239

Table 13.17 Premarital sexual intercourse in the past year and condom use during premarital sexual intercourse among youth ...241

Table 13.18 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months ...243

Table 13.19 Age mixing in sexual relationships among women age 15-19 ...245

Table 13.20 Drunkenness during sexual intercourse among youth ...247

Table 13.21 Recent HIV tests among youth ...249

Figure 13.1 Knowledge of Two HIV Prevention Methods (Using Condoms and Limiting Sexual Intercourse to One Uninfected Faithful Partner), by Residence and Education ...206

Figure 13.2 Comprehensive Knowledge about AIDS, by Residence and Education ...210

Figure 13.3 Women and Men Seeking Treatment for STIs ...231

Figure 13.4 Type of Facility Where Last Medical Injection Was Received ...233

Figure 13.5 Abstinence, Being Faithful, and Condom Use (ABC) among Young Women and Men Age 15-24 ...244

CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 14.1 Employment and cash earnings of currently married women and men...252

Table 14.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women ...253

Table 14.2.2 Control over men's cash earnings ...255

Table 14.3 Women's control over her own earnings and over those of her husband...256

Table 14.4.1 Women's participation in decision making...257

Table 14.4.2 Women's participation in decision making according to men ...258

Table 14.5.1 Women's participation in decision-making by background characteristics ...259

Table 14.5.2 Men's attitude toward wives' participation in decision making ...261

Table 14.6.1 Attitude toward wife beating: Women ...264

Table 14.6.2 Attitude toward wife beating: Men...265

Table 14.7.1 Attitude toward refusing sexual intercourse with husband: Women ...267

Table 14.7.2 Attitude toward refusing sexual intercourse with husband: Men ...268

Table 14.7.3 Men's attitude toward a husband's rights when his wife refuses to have sexual intercourse ...270

Table 14.8 Indicators of women's empowerment ...272

Table 14.9 Current use of contraception by women's status...273

Table 14.10 Women's empowerment and ideal number of children and unmet need for family planning...274

Table 14.11 Reproductive health care by women's empowerment...275

Figure 14.1 Number of Decisions in Which Currently Married Women Participate...262

APPENDIX A SAMPLE DESIGN Table A.1 Sample allocation ...281

Table A.2.1 Sample implementation by residence ...282

Table A.2.2 Sample implementation by region ...283

APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors...287

Table B.2.1 Sampling errors for the total sample...288

Table B.2.2 Sampling errors for the Urban sample...289

Table B.2.3 Sampling errors for the Georgetown urban sample ...290

Table B.2.4 Sampling errors for the rest of urban sample (other than Georgetown urban) ...291

Table B.2.5 Sampling errors for the Rural sample ...292

Table B.2.6 Sampling errors for the Coastal total sample...293

Table B.2.7 Sampling errors for the Coastal urban sample...294

Table B.2.8 Sampling errors for the Coastal rural sample ...295

Table B.2.9 Sampling errors for the Interior sample...296

Table B.2.10 Sampling errors for the Region 1 sample ...297

Table B.2.11 Sampling errors for the Region 2 sample ...298

Table B.2.12 Sampling errors for the Region 3 sample ...299

Table B.2.13 Sampling errors for the Region 4 sample ...300

Table B.2.14 Sampling errors for the Region 5 sample ...301

Table B.2.15 Sampling errors for the Region 6 sample ...302

Table B.2.16 Sampling errors for the Region 7 sample ...303

Table B.2.17 Sampling errors for the Region 8 sample ...304

Table B.2.18 Sampling errors for the Region 9 sample ...305

Table B.2.19 Sampling errors for the Region 10 sample ...306

Table B.3 Sampling errors for fertility rates for the three-year period before the survey ...307

Table B.4.1 Sampling errors for mortality rates for the five-year period preceding the survey and for the infant mortality rates by five-year periods...307

Table B.4.2 Sampling errors for mortality for the ten-year period preceding the survey ...308

APPENDIX C DATA QUALITY TABLES

Table C.1 Household age distribution ...310

Table C.2.1 Age distribution of eligible and interviewed women...311

Table C.2.2 Age distribution of eligible and interviewed men ...311

Table C.3 Completeness of reporting...311

Table C.4 Births by calendar years...312

Table C.5 Reporting of age at death in days ...312

Table C.6 Reporting of age at death in months ...312

Table C.7.1 Nutritional status of children by NCHS/CDC/WHO International Reference Population according to demographic characteristics ...313

Table C.7.2 Nutritional status of children by NCHS/CDC/WHO International Reference Population according to socioeconomic characteristics ...314

FOREWORD

Guyana is increasing efforts to put together a comprehensive set of tools for the monitoring and evaluation of health and the social determinants of health under a new paradigm. The Ministry of Health (MoH) is demonstrating that information and statistics are important ingredients for the strengthening of health systems and the improvement of services. I am therefore happy to introduce Guyana’s first Demographic and Health Survey (GDHS), conducted in 2009 by the Ministry in collaboration with the Bureau of Statistics of Guyana and with technical assistance from ICF MACRO.

The GDHS was designed to provide nationally representative data on housing and household characteristics in areas of education; maternal and child health; nutrition; family planning; gender; and knowledge, attitudes, and behaviors concerning HIV and other risk factors.. The survey has provided valuable and timely data to go along with other indicators for the Government of Guyana (GoG) and its many partners in health care−the Pan American Health Organization/World Health Organization (PAHO/WHO), the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the President’s Emergency Plan for AIDS Relief (PEPFAR), among others.

The 2009 GDHS sampled about 6,000 households and completed interviews with 4,996 womenand 3,522 men, age 15-49. Information was also collected on all children of the women in the sample . All households successfully enrolled in the study were asked questions regarding the physical dwelling, ownership of various durable goods, and characteristics of usual residents of the household. In-depth individual interviews were used to collect information from women and men age 15- 49 on smoking, diet, and sexual activity and practices, as well as knowledge of HIV/AIDS, experience with HIV testing, and attitudes regarding people living with HIV/AIDS.

It is hoped that the data collected through the GDHS will inform our efforts to develop the policies and programs to respond to the health needs of all Guyanese. The survey information can complement other survey data and national data in informing us of the health of the people.

I would like to express my gratitude to the GDHS technical and managerial staff at the Ministry of Health, whose efforts made this report possible.

I would also like to thank the Guyana Bureau of Statistics, the agency asked to conduct this survey.

Finally, I would like to thank ICF Macro for their technical assistance to the project under the MEASURE DHS program and the U.S. Agency for International Development (USAID) for their financial support.

Dr. Leslie Ramsammy

Minister of Health

SUMMARY OF FINDINGS

This document contains the main results of the 2009 Guyana Demographic and Health Survey (2009 GDHS). The 2009 GDHS is the first household-based, comprehensive survey on demographics and health (especially maternal and child health) to be carried out in Guyana.

The survey was conducted by the Bureau of Statistics (BOS) and the Ministry of Health (MOH) of Guyana. ICF Macro of Calverton, Maryland, provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding to cover technical assistance by ICF Macro and local costs was provided in its entirety by the USAID Mission in Georgetown, Guyana.

The primary objective of the 2009 GDHS was to collect information on characteristics of the households and their members, including exposure to malaria and tuberculosis; infant and child mortality;

fertility and family planning; pregnancy and postnatal care; childhood immunization, health, and nutrition; marriage and sexual activity; and HIV/AIDS indicators.

Other objectives of the 2009 GDHS included (1) supporting the dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country and (2) enhancing the survey capabilities of the institutions involved to facilitate surveys of this type in the future.

The 2009 GDHS sampled 5,632 households and completed interviews with 4,996 women age 15-49 and 3,522 men age 15-49. Three questionnaires were used for the 2009 GDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. The content of these questionnaires was based on the model questionnaires developed by the MEASURE DHS program of ICF Macro.

F ERTILITY

Fertility Levels and Differentials

If fertility were to remain constant in Guyana, women would bear, on average, 2.8 children by the end of their reproductive lifespan. The total fertility rate (TFR) is close to replacement level in urban areas (2.1 children per woman), and higher in the rural areas (3.0 children per woman). The TFR in the Interior area (6.0 children) is more than twice as high as the TFR in the Coastal area (2.4 children per woman) and is three times the fertility in the Georgetown (urban) area (2.0 children). The TFRs for women in the Interior area are significantly higher for all age groups.

The TFR is extremely high in some regions of Guyana: 6.9 children per woman in Region 1, 6.1 children per woman in Region 8, and 5.7 children per woman in Region 9. Region 1 also has the highest percentage of women currently pregnant (15 percent), which is several times the national average of 4 percent.

Fertility decreases rapidly with increasing education of women and increasing socioeconomic

status of the household. The TFR for women with more than secondary education (1.7 children per

woman) clearly indicates very low fertility among highly educated women. On the other hand, the TFR

for women with primary education (3.8 children) exceeds the fertility rate of women with higher

education by over two children. Fertility decreases with wealth; the TFR for women in the poorest quintile is very high (4.9 children), 2.5 times the level of fertility for women in the highest quintile (1.9 children).

Fertility Preferences

Fifty-six percent of currently married women reported that they don’t want to have a/another child, and five percent are already sterilized. The figures for men are 51 and 1 percent, respectively. The desire to stop childbearing increases rapidly as the number of children increases. Among respondents with one child, around one in five wants no more children. Among those with three children, about eight in ten women and seven in ten men want no more children.

Among women who want to have a child or another child (32 percent), half (16 percent) want to delay the birth for two or more years. Thirty-five percent of men want to have a/another child, but less than half of them (14 percent) want to wait two or more years.

Currently married women in urban areas are somewhat less likely than those in rural areas to want to limit childbearing (58 percent versus 62 percent). Additionally, currently married women in the Coastal area (61 percent) are less likely than women in the Interior area (67 percent) to want no more children. Close to seven in ten currently married women in Regions 1, 2, 6, and 9 are either sterilized or want no more children compared with 55 percent in Region 3 and 57 percent in Region 4.

The largest differences in the desire for no more children among currently married women are observed by educational level. Seventy-six percent of women with no education or primary education want no more children compared with 48 percent of women with more than secondary education. The percentage of women who want to limit childbearing decreases as the wealth quintile increases, from 68 percent of women in the lowest quintile to 58 percent of women in the highest two wealth quintiles.

F AMILY P LANNING Use of Contraception

Forty-three percent of women who are currently married or in union are currently using a contraceptive method, mainly a modern method (40 percent). The methods most commonly used by currently married women are the male condom (13 percent), the pill (9 percent), and the IUD (7 percent).

Female sterilization and injectables are each used by 5 percent of women. The 2009 GDHS prevalence rate of 43 percent represents an increase of 8 percentage points since the 2005 GAIS (35 percent). Most of the increase was in condom use, injectables, and female sterilization.

The level of contraceptive use increases with the level of education, from 22 percent among women with no education to 46 percent among women with more than secondary education. The level of contraceptive use increases with the number of living children (up to 4 children), from 16 percent of women with no children to 51 percent of those with 3 to 4 children, after which it decreases to 46 percent for women with 5 or more children. Similarly, the percentage of women currently using contraception increases with women’s age, from 30 percent among women age 15-19 to 50 percent among women age 30-34, after which it decreases to reach 33 percent among women age 45-49.

The current use of contraception is similar for women in Urban, Rural, and Coastal areas (42-44

percent), but it is much lower among women in the Interior area (31 percent). The method mix among

women in the Urban and Rural areas is slightly different: Rural area women are more likely to use the

condom, the pill, and the IUD, while Urban area women are more likely to use the condom, the IUD, and

female sterilization.

Unmet Need for Family Planning

Twenty-nine percent of currently married women have an unmet need for family planning, mostly for limiting births (19 percent) compared with spacing (10 percent). Because 43 percent of married women are currently using a contraceptive method (met need), the total demand for family planning is estimated at 71 percent of married women (22 percent for spacing, 49 percent for limiting). As a result, only 60 percent of the total demand for family planning is met.

The unmet need for family planning is highest among youngest women age 15-19 (35 percent, mostly for spacing) and declines with age to 26 to 28 percent among women age 40-49 (mostly for limiting).

In Urban, Rural, and Coastal areas, 27 to 29 percent of women have an unmet need, compared with 37 percent in the Interior area. By region, unmet need ranges from 26 percent in Regions 3 and 10 to 46 percent in Region 1.

Unmet need for spacing increases steadily with education while unmet need for limiting declines with education. As a result, unmet need remains relatively constant among educational groups (28 to 31 percent), with the exception of women with no education who have a much higher percentage of unmet need (41 percent). Both unmet need for spacing and unmet need for limiting are highest for women in the lowest wealth quintile, and they tend to decline with increasing socioeconomic status of the household.

Overall, 38 percent of women in the lowest wealth quintile have unmet need for family planning compared with 24 percent of women in the highest quintile.

M ATERNAL H EALTH Antenatal Care

Among women who had a birth in the five years preceding the survey, 92 percent received antenatal care (ANC) from a skilled health provider for their most recent birth (51 percent from a nurse/midwife and 35 percent from a doctor). Older mothers (35-49 years) are less likely to receive antenatal care by a skilled health provider than younger mothers. Eighty-six percent of women with no education received ANC from a skilled health provider compared with 95 percent of women with more than secondary education.

Urban women are more likely than Rural area women to have received antenatal care from a skilled health provider (98 and 90 percent, respectively). The lowest percentage of women who received antenatal care from a skilled health provider is in the Interior area (78 percent). Antenatal care from a skilled health provider is almost universal in Regions 3, 4, 5, 6, and 10, compared with only 35 percent of women in Region 9. Forty-two percent of women in Region 9 received ANC by a community health worker for their most recent birth. Nurses/midwives provide antenatal care for a large proportion of women in Region 6 (79 percent) and in Region 1 (70 percent). On the other hand, a large percentage, more than half (53 percent) of women in Region 4 receive ANC from a doctor.

Antenatal care is more beneficial in preventing adverse outcomes when it is sought early in the

pregnancy and is continued through to delivery. Under normal circumstances, the World Health

Organization (WHO) recommends that a woman without complications have at least four antenatal care

visits, the first of which should take place during the first trimester. Almost eight in ten women (79

percent) with a live birth in the five years preceding the survey had four or more antenatal care visits, as

recommended. Almost half of the visits (49 percent) took place during the first trimester, ranging from a

low of 42 percent in the Interior area to 67 percent in the Georgetown (urban) area. The median number

of months pregnant at the first visit for women who received ANC was 4 months.

Delivery Care

Overall, 92 percent of births in the five years preceding the survey were assisted by a skilled birth provider, mainly by a nurse or midwife (56 percent), followed by a doctor (31 percent). Births to mothers under age 35 and lower order births are more likely to have assistance at delivery by a skilled provider than births to older mothers and higher order births. By residence, births in Urban areas are more likely than those in Rural areas, and births in the Coastal area are more likely than births in the Interior area, to be assisted by a skilled health provider. The percentage of births assisted by a skilled provider ranges from a low of 57 percent in Region 9 to a high of 98 percent in Region 4. Births to mothers who have more education and births in the higher wealth quintiles are more likely to be assisted by a skilled provider than other births. Almost all births to mothers with more than secondary education (98 percent) are assisted by a skilled provider compared with 71 percent of births to mothers with no education.

Caesarean section

One in eight births (13 percent) in the five years preceding the survey was delivered by caesarean section. The prevalence of C-section delivery increases steadily with mother’s age and decreases with birth order. Regions 1, 6, 7, and 9 have the lowest levels of deliveries by C-section (2-5 percent) and Region 3 has the highest level (23 percent). The percentage of births delivered by C-section increases with a mother’s education and generally increases with her wealth.

C HILD H EALTH

Infant and Child Mortality

Childhood mortality rates in Guyana are relatively low. For every 1,000 live births, 38 children die during the first year of life (infant mortality), and 40 children die during the first five years (under-age 5 mortality). Almost two-thirds of deaths in the first five years (25 deaths per 1,000 live births) take place during the neonatal period (the first month of life). The mortality rate after the first year of life up to age 5 (child mortality) is also very low at 3 deaths per 1,000 live births. The 2009 GDHS mortality data do not show any clear trends over time. However, mortality data have to be interpreted with caution because sampling errors associated with mortality estimates are large.

All indicators of childhood mortality are higher in Urban than in Rural areas. For example, infant mortality is 45 deaths per 1,000 live births in Urban areas and 32 deaths per 1,000 live births in Rural areas. Childhood mortality is higher in the Coastal than in the Interior area for most indicators. The infant mortality rate is 37 deaths per 1,000 live births in the Coastal area compared with 27 deaths per 1,000 live births in the Interior area.

Early childhood mortality is generally lower among children in the poorer quintiles and higher among children in the wealthiest quintiles. For example, children in the wealthiest quintile are more likely to die during the first year of life (44 deaths per 1,000 live births) than children in poor households (25 deaths per 1,000 live births). The patterns in childhood mortality by mother’s education are not clear due to the small number of cases under each education category. Mortality rates among children born to the oldest mothers (age 30-39) are almost twice as high as mortality rates among children born to the youngest mothers. Furthermore, higher-parity children (parity 7 or higher) have higher childhood mortality rates than children of birth orders 2 through 6. Short birth intervals (i.e., less than two years) are clearly associated with higher mortality both during and after infancy, supporting the importance of child spacing for child survival.

Almost half the children in Guyana (48 percent) are in so-called avoidable high-risk categories,

although mostly in single high-risk categories, because they were born of birth order 4 or higher (13

percent); born after a short birth interval of less than 24 months (9 percent); or born to mothers less than

18 years old and, thus, considered very young (9 percent) or to mothers age 35 or older (4 percent).

Fourteen percent of children in an avoidable high-risk category are classified in the multiple high- risk category, mostly because the mother is 35 years or older and the birth order is high (6 percent); and also because of a short birth interval and a high birth order (5 percent). The latter group of children is of particular concern because they are almost five times more likely to die than children who are not in any high-risk category (the risk ratio is 4.5).

Vaccination Coverage

Overall, 63 percent of Guyanese children age 18-29 months are fully immunized, and only 5 percent of the children received no vaccinations at all. Looking at coverage for specific vaccines, 94 percent of children received the BCG vaccination, 92 percent received the first dose of pentavalent vaccine, and 78 percent received the first polio dose (Polio 1). Coverage for the pentavalent and polio vaccinations declines with subsequent doses; 85 percent of children received the recommended three doses of pentavalent vaccine, and 70 percent received three doses of polio. These figures reflect dropout rates of 8 percent for the pentavalent vaccine and 11 percent for polio; the dropout rate represents the proportion of children who received the first dose of a vaccine but who did not get the third dose. Eighty-two percent of children are vaccinated against measles, and 79 percent of children have been vaccinated against yellow fever.

Full vaccination coverage is lower for first- and sixth- or higher-order births (56 and 50 percent, respectively). Full vaccination coverage decreases with an increase in mother’s education, and it is lowest for children in the lowest and highest wealth quintiles. There are no major variations in vaccination coverage by residence. However, children in the Interior area are somewhat less likely to be vaccinated than other children. This is especially true when looking at specific vaccines, indicating a need for scaling up efforts in the Interior area to reach more children and to improve the quality of vaccination services, including recording and monitoring systems.

Illnesses and Treatment

Acute Respiratory Infections (ARI)

Five percent of children under age 5 had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Among children with symptoms of ARI, advice or treatment was sought from a health facility or provider for 65 percent, and antibiotics were prescribed as treatment for 18 percent (data not shown).

Fever

Fever was found to be moderately frequent in children under age 5 in Guyana (20 percent), ranging from 17 percent in children under 6 months to about 26 percent in children 12–17 months.. Most of the children under age 5 with fever (59 percent) were taken to a health facility or a health provider for their most recent episode of fever. Overall, about one in five children with fever (21 percent) received antibiotics, and 6 percent received antimalarial drugs.

Diarrhea

Overall, about 10 percent of children were reported to have diarrhea in the two weeks immediately before the survey, with just 1 percent reporting bloody diarrhea. Overall, about six in ten children under age 5 with diarrhea (59 percent) were taken to a health facility or health provider for advice or treatment. Male children (55 percent) are less likely than female children (63 percent) to be taken for treatment or advice to a health facility or provider. Additionally, children living in the Coastal area are much less likely to be taken for treatment or advice (50 percent) than children in the Interior area (79 percent).

Oral rehydration therapy (ORT) was given to almost six in ten children (59 percent), half of the

children (50 percent) received ORS packets or pre-packaged liquid, and one in six (16 percent) received

recommended home fluid (RHF). In total, 64 percent of children with diarrhea received ORT or increased fluids.

Antibiotics are generally not recommended to treat non-bloody diarrhea in young children.

Twelve percent of children with diarrhea received antibiotics, even though only 1 percent of children under age 5 had a bloody diarrhea. Four percent of children received antimotility drugs, and 1 percent received zinc supplements. One in four children (25 percent) received home or other remedies for their diarrhea.

About one in five children with diarrhea (18 percent) did not receive any treatment at all. Urban children are more than twice as likely as rural children (36 versus 15 percent) and children living in the Coastal area are almost five times as likely as children in the Interior area (24 percent versus 5 percent) to receive no treatment at all for their diarrhea.

N UTRITION OF C HILDREN Height and Weight

Almost one in five children (18 percent) under age 5 is short for age or stunted, and one in twenty (5 percent) is severely stunted. As expected, stunting, which reflects chronic malnutrition, rises with age during the first year. Stunting is lower among children whose mothers have more than secondary education (16 percent). Children in Rural areas are almost twice as likely to be stunted as children in Urban areas (20 and 11 percent, respectively). The highest levels of stunting are found among children in the Interior area (35 percent).

Based on the weight-for-age index, 11 percent of children (over one in ten) in Guyana are underweight, and about 2 percent are severely underweight. Boys are somewhat more likely to be underweight than girls (12 and 9 percent, respectively), and children in Rural areas are more likely to be underweight than children in Urban areas (12 and 7 percent, respectively).

Based on the weight-for-height index, 5 percent of children under age 5 are considered wasted, and just 1 percent are severely wasted.

Anemia

Overall, about four in ten (39 percent) children age 6-59 months have some level of anemia, in- cluding 23 percent of children who are mildly anemic, 15 percent who are moderately anemic, and less than 1 percent with severe anemia. Prevalence of any anemia is highest for children 9-11 months (74 percent) and lowest for those 36-59 months (25 to 28 percent). More than half of children in Region 1 are anemic (51 percent) compared with three in ten (30 percent) in Region 8. The percentage of children with anemia is lowest among children of mothers with secondary or higher education (38-40 percent) and among children of mothers in the highest wealth quintile (32 percent).

Malaria

Eighty-nine percent of households own a mosquito net, whether treated or untreated, and 66 percent of households own more than one net. Rural households are more likely to own at least one net than urban households (90 percent versus 85 percent). About nine in ten households (89 percent) in the malaria-endemic regions (Regions 1, 7, 8, and 9) have at least one mosquito net.

About three in ten households (29 percent) own at least one ever-treated net, and more than one in

four (26 percent) households owns an insecticide-treated net. Rural area households are more than twice

as likely as Urban area households to own an ITN (31 percent versus 13 percent), and households in the Interior area are more likely than those in the Coastal area to own at least one ITN (34 percent versus 25 percent). About four in ten households in the malaria-endemic regions (38 percent) have at least one ITN.

The percentage of households with at least one ITN is lowest for households in the highest wealth quintile (17 percent) compared with other households (25 to 29 percent).

The average number of mosquito nets per household is two.

Eight in ten children under age 5 in all households in Guyana slept under a mosquito net (treated or untreated) the night before the survey; about three in ten (29 percent) slept under an ever-treated net;

and about one in four (24 percent) slept under an ITN. In households that own at least one ITN, a substantially larger proportion of children under age 5 slept under an ITN the night before the survey (81 percent).

HIV/AIDS

Knowledge of HIV Prevention Methods

Knowledge of AIDS is almost universal in Guyana—97 percent of women and men have heard of AIDS. There are minor variations in knowledge of AIDS by age, marital status, or residence. The only exception is the level of knowledge in the Interior area, which is the lowest for both women (89 percent) and men (95 percent).

More than eight in ten respondents age 15-49 know that consistent use of condoms is a means of preventing the spread of HIV (81 percent of women and 84 percent of men) and that limiting sexual intercourse to one HIV-negative and faithful partner can reduce the chances of contracting HIV (82 percent of women and 85 percent of men).

A smaller proportion of respondents (73 percent of women and 77 percent of men) reported that both methods—using condoms and limiting sexual intercourse to one HIV-negative partner who has no other partners—are ways of avoiding HIV transmission. Thus, knowledge is higher among men than women for each of the three specified prevention methods.

An equal proportion of women and men age 15-49 (78 percent, each) know that abstinence is a way to reduce risk of getting HIV.

Beliefs about AIDS

About nine in ten Guyanese adults know that a healthy-looking person can have the AIDS virus (87 percent of women and men) or that AIDS cannot be transmitted by supernatural means (87 percent of women and 88 percent of men). About three-quarters of women (73 percent) and two-thirds of men (65 percent) are aware that the AIDS virus cannot be transmitted through mosquito bites. Furthermore, 84 percent of women and 79 percent of men know that the AIDS virus cannot be contracted by sharing food with a person who has AIDS. These findings show that the two most common local misconceptions are that the HIV virus can be transmitted (1) by mosquito bites and (2) by sharing food with someone with AIDS.

Overall, more than half of women (53 percent) and more than four in ten men (46 percent) in

Guyana have a comprehensive knowledge of HIV/AIDS transmission and prevention methods, i.e., they

know that condom use and limiting sex to one uninfected partner are HIV prevention methods; they are

aware that a healthy looking person can have the AIDS virus; and they reject the two most common local

misconceptions (that AIDS can be transmitted by mosquito bites and by sharing food with someone with AIDS).

Younger women are somewhat more likely to have a comprehensive knowledge about AIDS than older women, while among men there is no major difference by age. Respondents who have ever had sex have a much higher level of comprehensive knowledge than those who have never had sex. Currently married women (48 percent) are less likely than never married women (61 percent) or formerly married women (60 percent) to have a comprehensive knowledge of AIDS, while among men the variation is not pronounced. Urban respondents and those living in the Coastal area are much more likely to have comprehensive knowledge about AIDS than respondents in the Rural and Interior areas. For example, 70 percent of women in Urban areas have comprehensive knowledge about AIDS compared with 46 percent of women in Rural areas; and 54 percent in the Coastal area have such knowledge compared with 41 percent of women in the Interior area.

For women, the lowest percentage of comprehensive knowledge about AIDS is in Region 9 (31 percent) and the highest is in Region 10 (63 percent), while for men it ranges from 26 percent in Region 5 to 64 percent in Region 10.

Education and wealth status have a strong positive correlation with the likelihood of having a comprehensive knowledge of AIDS. The percentage with comprehensive knowledge increases from 20 percent among women and 11 percent among men with no education to 78 and 75 percent, respectively, among women and men with secondary or higher education. Similar patterns are observed in the variation of this indicator by wealth. Thirty-two percent of women and 28 percent of men in the lowest wealth quintile have a comprehensive knowledge of AIDS compared with 68 percent of women and 65 percent of men in the highest wealth quintile.

Mother-to-Child Transmission

About eight in ten women (79 percent) and seven in ten men (67 percent) know that HIV can be transmitted by breastfeeding. Sixty-eight percent of women and 54 percent of men are aware that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking drugs during pregnancy.

Overall, 60 percent of women and 43 percent of men know both facts: (1) HIV can be transmitted through breastfeeding and (2) the risk of MTCT can be reduced by the mother taking special drugs during pregnancy.

Both individual indicators, as well as the combination indicator (knowledge that HIV can be transmitted by breastfeeding and knowledge that the risk of MTCT can be reduced by the mother taking special drungs during pregnancy), have shown significant improvement over the same period. For women, knowledge of the combination indicator has increased from 39 percent in 2005 to 60 percent in 2009, and for men it has increased from 28 percent in 2005 to 43 percent in 2009.

Attitudes toward Negotiating Safer Sex

Almost nine in ten respondents (89 percent of women and 88 percent of men) feel that a wife is justified in refusing to have sexual intercourse with her husband if she knows that he has a sexually transmitted disease. Ninety-six percent of women and men agree that a woman is justified in either refusing sexual intercourse with her husband or in asking him to use a condom if she knows that he has an STI.

Attitudes toward Educating Children on Condom Use

Overall, more than eight in ten women (81 percent) and men (86 percent) age 18-49 agree that

children age 12-14 should be taught to use condoms to avoid AIDS. Older respondents age 40-49 are

slightly less likely than younger respondents to support education of children age 12-14 about condom use to prevent AIDS. Women and men living in the Coastal area (82 and 86 percent, respectively) are more likely than women and men living in the Interior area (73 and 82 percent, respectively) to agree about education on condom use of children age 12-14.

Fifty-eight percent of women and 61 percent of men with no education agree on instructing children age 12-14 about condoms, compared with 85 percent of women and 86 percent of men with more than secondary education. For women, the percentage who agree that children age 12-14 should be taught about condoms increases from 72 percent among those in the lowest wealth quintile to 85 percent among women in the highest wealth quintile. Among men, there is no clear pattern in the variation of this indicator by wealth.

Higher-risk Sex

A larger proportion of men (10 percent) than women (1 percent) reported having had more than one sexual partner in the 12 months preceding the survey. Additionally, a higher percentage of men (30 percent) than women (17 percent) reported having had sex with a person who was neither their spouse nor their cohabiting partner (higher-risk sex) in the year before the survey.

Among respondents who reported having had higher-risk intercourse (with a person who was neither their husband nor who lived with them) in the past 12 months, about half of women (52 percent) and seven in ten men (72 percent) used a condom at the last higher-risk sex. The smaller proportions of women with multiple partners, higher-risk sexual intercourse, and condom use, compared with men, may accurately reflect the context, but it may also reflect a bias from some women being hesitant to report behavior that may not be widely accepted.

Condom use in the past 12 months by respondents who had higher-risk sexual intercourse is more likely among young people age 15-19, never married respondents, respondents living in an Urban area, women living in the Coastal area, and respondents in Region 10. Condom use during last higher-risk sexual intercourse is higher among men with more than secondary education. For both women and men, it is highest among those in the highest wealth quintile.

HIV/AIDS-Related Knowledge and Sexual Behavior among Young Adults

About half of respondents age 15-24 (54 percent of women and 47 percent of men) have a comprehensive knowledge of AIDS (i.e., they know that people can reduce their chances of getting the AIDS virus by having sex with only one uninfected, faithful partner and by using condoms consistently;

know that a healthy-looking person can have the AIDS virus; and know that HIV cannot be transmitted by mosquito bites or by supernatural means).

Overall, about four in ten women age 15-24 (41 percent) and men age 15-24 (39 percent) in Guyana have never had sex, and an additional 6 percent of women and 9 percent of men have had sex but not in the 12 months before the survey. Furthermore, the proportion of young people who had multiple sexual partners in the past 12 months is not large—1 percent of women and 12 percent of men. Less than 1 percent of young women and 3 percent of young men who had sex with more than one partner in the past 12 months did not use a condom the last time they had sex.

One in ten women (10 percent) age 15-24 and one in five men (19 percent) age 15-24 had sex by

age 15, up from 9 and 13 percent, respectively, in the 2005 GAIS. The percentage of respondents age 18-

24 who had sex before exact age 18 increases rapidly to 46 percent for women and 60 percent for men, a

decrease from 59 percent for women and 68 percent for men in the 2005 GAIS.

Condom use at first sex is not very common in Guyana. Among young adults age 15-24 who have ever had sexual intercourse, only 46 percent of females and 54 percent of males used a condom the first time they had sex. Never-married women and men (63 and 59 percent, respectively) are much more likely to use a condom at first sex than those who have been married (34 and 35 percent, respectively). Use is also markedly higher among respondents who know where to obtain a condom (49 percent of women and 55 percent of men) than among those who do not have such knowledge (27 percent of women and 25 percent of men). Young women and men who live in Urban areas and in the Coastal area, and those who live in Region 10, are more likely to use a condom at first sex than other young adults. As expected, young women and men with more than secondary education (68 and 58 percent, respectively) and in the highest wealth quintiles (64 and 58 percent, respectively) are the most likely to use a condom at first sex compared with those who have less or no education or are in the lowest wealth quintiles.

Among youth who had sexual intercourse in the past 12 months, higher-risk sex is more common

among young men (80 percent) than among young women (42 percent). Condom use at last higher-risk

sexual intercourse is also higher among young men (78 percent) than young women (56 percent). Higher-

risk sex is more prevalent among younger respondents and among those who have never married. Urban

respondents age 15-24 and those living in the Coastal area are more likely to have higher-risk sexual

intercourse than rural respondents and those living in the Interior area. The variation is more pronounced

among women than men. The proportion of youth age 15-24 who reported higher-risk sexual intercourse

in the 12 months preceding the survey increases with level of education and wealth quintile. Condom use

at the last higher-risk sex generally follows the same patterns.